September 20, 2010 in Nation/World

Spiriva an alternative for adults with asthma

Thomas H. Maugh Ii Los Angeles Times
 
Millions suffer

About 17 million Americans, 12 million of them adults, suffer from asthma, which is characterized by coughing and difficulty breathing caused by inflammation of the airways. About 85 percent of them can be successfully managed with existing approved drugs, said Robert Smith, program director for the National Heart, Lung and Blood Institute’s asthma clinical research network.

LOS ANGELES – Spiriva, a drug that is already widely used to treat chronic obstructive pulmonary disease, can provide significant relief of symptoms for adult asthmatics who have difficulty obtaining relief with other drugs, researchers said Sunday.

In particular, the drug is expected to provide an alternative to long-acting beta-agonists, such as Serevent, Advair and Symbicort, which have been shown occasionally to exacerbate asthma symptoms, leading to hospitalization and even death.

A particular strength of Spiriva, known generically as tiotropium bromide, is that its effects last for 24 hours or more, providing long-lasting relief for patients, said Dr. Michael D. Roth, a professor of pulmonary and critical care medicine at the University of California – Los Angeles’ David Geffen School of Medicine, who was not involved in the research. “It provides daylong relief so that patients don’t have to think about getting in trouble partway through the day,” he said.

“When we’re desperate, we throw the kitchen sink at patients, and tiotropium does give them some relief,” added Dr. Paryus Patel, a pulmonary specialist at Marina Del Rey Hospital who said he already prescribes the drug on occasion. The new study, published online in the New England Journal of Medicine and reported Sunday at a meeting in Barcelona, Spain, of the European Respiratory Society, means that “people who shied away from using this now have an alternative for symptom relief.”

The conventional treatment is low to moderate doses of inhaled steroids. When those are inadequate, current guidelines call for increasing the dose of steroids or adding a long-acting beta-agonist. But higher doses of steroids do not work for all patients, and they increase the risk of sore throats and pneumonia. Beta-agonists present other risks.

In the new study, a team headed by Dr. Stephen Peters of Wake Forest University Baptist Medical Center enrolled 210 adults whose asthma was not well-controlled by low doses of inhaled steroids.

There have been some concerns in the last couple of years about a potential for increased risk of heart attacks, stroke and death associated with tiotropium. But in an article Thursday in the New England Journal of Medicine, scientists from the Food and Drug Administration summarized their analysis of the existing data and concluded that those risks had not been confirmed.

Peters noted that the asthma clinical research network is now gearing up for longer trials of the drug to ensure that there are no unforeseen side effects.


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